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Gentamicin

Overview

Gentamycin is an aminoglycoside antibiotic isolated from Micromonospore purpurea. The aminoglycosides are the compound containing characteristic amino sugars joined to a hexose nucleus in glycoside linkage. Aminoglycosides are polycations and their polarity accounts for their pharmakokinetic properties. Gentamycin is effective against both gram positive and gram negative bacteria. Gentamicin (Sulphate) is active alone but also exibit synergism with ß lactam antibiotic. Antibiotics require constant drug level in body for therapeutic effect. This is achieved by taking the medication at regular interval of time throughout the day and night as prescribed. Gentamicin (Sulphate) is important to take the drug for the full time period as prescribed. If you discontinue the therapy, it may result in ineffective treatment.

Category:

Primary Characterstics

Molecular Structure of Gentamicin
Gentamicin (Sulphate), Gentamicin (Sulphate) are the derivatives of Gentamicin. It is of Semi Synthetic origin and belongs to Aminoglycoside. It belongs to Amebicides pharmacological group on the basis of mechanism of action.

Pharmacokinetics

Volume of distribution is found to be 0.2 l/kg and plasma protien binding is < 25%. Renal Excretion accounts for 80% and plasma half life is 1.5-2.5 hr.

Indications

Contraindications

Gentamicin is contraindicated in conditions like Renal diseases,Hypersensitivity.

Drug Interactions

Gentamicin is known to interact with other drugs, the details of drug interactions is as follows:

DrugDetailsSeverityOnsetManagement
Atracurium (Besylate)Coadministartoin results in severe respiratory depression by decreasing the release of acetylcholine at neuromuscular junction by interfering with calcium influx.MajorCoadministration must be avoided. Vital signs should closely monitored and dose adjustment is necessary. Coadministration must be avoided. Vital signs should closely monitored and dose adjustment is necessary. Coadministration must be avoided. Vital signs should closely monitored and dose adjustment is necessary.
CapreomycinRespiratory paralysis and renal dysfunction risk is increased if this combination is used.MajorThis combination should be avoided.
Cefaclor (Monohydrate)coadministration of gentamicin and cephalosporin (e.g cefaclor, cephaloridine) increase nephrotoxicity.
Cefotaxime
Cisplatin
Clindamycin
Cyclosporin A
Cytarabine (HCl)
Ethacrynic Acid
Ethacrynic AcidDeafness may be more likely to occur if gentamycin is co-administered with IV ethacrynic acid.
Floxacillin (Na)
Foscarnet (Na)
Frusemide or FurosemideFrusemide may enhance the adverse/toxic effect of Gentamicin . Specifically, nephrotoxicity and ototoxicity. ModerateMonitor toxic effects of Gentamicin if Furosemide is initiated or the dose is increased. This is probably of most concern if Furosemide is administered in high doses for extended periods of time.
Hydrocortisonecoadministration may potentiate gentamicin nephrotoxicity
IndomethacinIndomethacin potentiates gentamicin nephrotoxicity.
Iotroxate (Meglumine)
NeomycinRespiratory paralysis and renal dysfunction risk is increased if this combination is used.MajorThis combination should be avoided.
Netilmicin (Sulphate)Respiratory paralysis and renal dysfunction risk is increased if this combination is used.MajorThis combination should be avoided.
OxaliplatinYou should inform your doctor before using this combination.Do not start or stop any medicine without doctor or pharmacist approval.
Pancuronium (Br)Gentamicin by interfering with Calcium influx decrease sensitivity of acetylcholine at postsynaptic membrane thus inhibit release of acetylcholine at neuromuscular junction resulting in severe respiratory depression and paralysis.Death may also reported due to additive effect of both drugs.MajorGentamicin is avoided when pancuronium is given during or immediately after surgery.Adjust dose.
Protamine (Sulphate)Protamine sulfate has been shown to be incompatible with Gentamicin.
Pyridostigmine (Br)
SalsalateWhen Salsalate are combined with Gentamicin the blood levels of Gentamicin may increase, presumably because the elimination of Gentamicin is reduced. This may lead to side effects from Gentamicin.
StreptomycinRespiratory paralysis and renal dysfunction risk is increased if this combination is used.MajorThis combination should be avoided.
Sulphacetamide
TobramycinRespiratory paralysis and renal dysfunction risk is increased if this combination is used.MajorThis combination should be avoided.
Vancomycin (HCl)

These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Interference in Pathology

  • Heparinized Blood Samples

Side Effects

The severe or irreversible adverse effects of Gentamicin, which give rise to further complications include Encephalopathy, Convulsions, Hallucinations, Nephrotoxicity, Neuromuscular blockage, Peripheral neuritis, Anaemia.

Gentamicin produces potentially life-threatening effects which include Neuromuscular blockage, Nephrotoxicity, Ototoxicity. which are responsible for the discontinuation of Gentamicin therapy.

The symptomatic adverse reactions produced by Gentamicin are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Vertigo, Fever, Ototoxicity, Skin rashes, Exfoliative dermatitis, Eosinophilia, Purpura, Angioedema, Pyuria, Proteinuria, Azotemia, Cylindruria, Local allergies, Cross sensitivity.

Available Brands

Click on the appropriate strength of the dosage form to view its available brands.

Single Ingredient

Inj: 5 mg/ml, 10 mg/ml, 20 mg/ml, 40 mg/ml, 50 mg/ml, 80 mg/ml,
Drops: 300 mg/ml,
Eye Drops: 0.3 %w/v, 3.5 %w/v,
Ear Drops: 0.3 %w/v,
Eye Oint: 0.3 %w/w,
E and E Drops: 0.3 %v/v, 0.3 %w/v,
Oint: 0.1 %,
Cream: 1 %w/w, 0.1 %w/w, 0.3 %w/w,
Eye Gel: 0.3 %w/w,

Multi ingredient

Inj: 80 mg,
Eye Drops: 0.3 %w/v,
Ear Drops: 0.3 %w/v,
Eye Oint: 0.3 %w/w,
E and E Drops: 0.3 %w/v,
Oint: 0.1 %w/w, 0.17 %w/w,
Cream: 1.7 mg, 0.1 %w/w, 0.3 %w/w, 0.12 %w/w, 0.001 %w/w,

Dosage

Gentamicin's dosage details are as follows:
Dose Single Dose Frequency Route Instructions

Adult Dosage

4 to 8 mg6 (6)As recommended.Intra ThecalAs Required
3 to 5 mg/kg4 (4)As recommended.IV,IMIn 3-4 divided doses for 7-10 days. Doses vary according to indication.
0.3 %0.3 (0.3)6 hourlyOtic1-2 drops
1.5 mg/kg/dose1.5 (1.5)As recommended.POFor prevention of becterial endocarditis. NOT to exceed 80 mg with ampicillin (1-2g). 30 minutes prior to procedures.
0.3 %0.3 (0.3)8 hourlyTopicalOr twice a day if needed.

Paedriatic Dosage ( 20 Kg. )

0.3 %0.3 (0.3)6 hourlyEar-
2 to 1.5 mg/kg1.8 (1.75)8 hourlyIntra Muscular
2.5 mg/kg2.5 (2.5)8 hourlyIntra Venous-
0.3 %0.3 (0.3)6 hourlyOpthalmic-
0.3 %0.3 (0.3)6 hourlyTopical-

Neonatal Dosage ( 3 Kg. )

2.5 mg/kg2.5 (2.5)8 hourlyIntramuscular
2.5 mg/kg2.5 (2.5)8 hourlyIntravenous
0.3 %0.3 (0.3)6 hourlyTopical

High Risk Groups

Drug should not be given to Pregnant Mothers, patients suffering from Kidney dysfunction, and Neonates.

If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.

Warning / Precautions

Gentamicin should be used with caution in patients with history of kidney diseases, vertigo, hearing loss, myasthenia gravis, parkinsonisms. It should be used with caution in patients who are sensitive to aminoglycosides. Keep patients well hydrated to prevent chemical irritation or nephrotoxic reactions. Take appropriate measures in case of secondary infections.

Storage Conditions

Inj, Eye Drops, Skin Oint or Cream

Store at room temperature, Below 30°C. Do not Freeze.

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